Objectives: To compare testosterone and gonadotropins characteristics of cryptorchidism in male adults before and after orchidopexy. Subjects and methods: In a follow-up study on 112 adult patients, who were operatived by orchidopexy.
Trang 1TESTOSTERONE AND GONADOTROPINS IN MALE ADULTS
WITH CRYPTORCHIDISM: COMPARE PRE- AND
POST-ORCHIDOPEXY
Nguyen Manh Thang*; Tran Quan Anh**; Nguyen Quang**
SUMMARY
Objectives: To compare testosterone and gonadotropins characteristics of cryptorchidism in male adults before and after orchidopexy Subjects and methods: In a follow-up study on 112 adult patients, who were operatived by orchidopexy Analyzing characteristics of their hormones including LH, FSH, testosterone, compared pre- and post-operation Results: Mean age was 25.69 ± 5.7 (15 - 43 years old) Average LH/FSH/testosterone Pre-orchidopexy: unilateral 6.7 ± 2.6/8.8 ± 6.9/17.0 ± 5.9 Bilateral: 11.6 ± 6.0/22.0 ± 13.7/14.5 ± 7.3 Post orchidopexy: average LH/FSH/testosterone were different between two groups: unilateral 5.8 ± 2.0/7.2 ± 5.3/18.8 ± 4.9 Bilateral 8.4 ± 3.6/15.6 ± 9.8/16.2 ± 5.8 Average LH, FSH decreased Average testosterone increased Conclusions: There is an improvement in testosterone and gonadotropin in male adults with cryptorchidism post-operation, althought there is difference between two groups: bilateral and unilateral
* Keywords: Adult cryptorchidism; Testosterone; Gonadotropins; Orchidopexy
INTRODUCTION
Cryptorchidism is one of the most
common congenital condition in the
pediatric population This is a disorder in
which one or both of the testes do not
descend spontaneously to the usual
position in the scrotum About 3% of
full-term and 30% of premature infant boys
are born with at least one undescended
testis [2, 6, 10] Cryptorchidism is more
commonly seen in premature males
because the testes do not descend from
the abdomen to the scrotal sac until the
seventh month of fetal development [2, 8]
Cryptorchidism is associated with
impairment of germ cell maturation and
subsequent infertility in adulthood It's
common knowledge that the increased temperature in undescended testis affects spermatogeneis rather than hormonal levels [4] Some researchers claim that testosterone is normal because Leydig cells are unaffected by temperature [4, 5, 7] But recently researches show testosterone decreases in bilateral cryptorchidism and normal in unilateral Why is testosterone low in bilateral if leydig is not affected?
On the other hand, FSH and LH are both increased in cryptorchidism Once again, why is LH increased if testosterone is supposed to be normal? We do this
thesis: To determine if cryptorchidism causes Leydig cell failure and androgen deficiency, producing low serum testosterone with high LH and FSH levels
* Haiphong Medical University
** Viet Duc Hospital
Corresponding author: Nguyen Manh Thang (nmthang@hpmu.edu.vn)
Trang 2SUBJECTS AND METHODS
112 adult patients with cryptorchidism who underwent orchidopexy during 2013 -
2014 at Vietduc Hospital Preoperation blood tests for testosterone and gonadotropin levels were compared with postoperative testosterone and gonadotropin level The data were analyzed to evaluate the changes in hormone level between pre- and post-orchidopexy
RESULTS
Table 1: Post-orchidopexy testosterone and gonadotropin
n = 76
Bilateral
Post orchidopexy: Average LH, FSH level are different between two groups unilateral and bilateral (p < 0.001) Average testosterone is still in nomal value, however bilateral group’s testosterone levels is lower than unilateral’s (p = 0.017)
Table 2: Unilateral: Compare pre- and post-orchidopexy testosterone and gonadotropin
Average Pre-orchidopexy
n = 76
Post-orchidopexy
Post orchidopexy of unilateral group: average LH, FSH reduce Average testosteron increases (p < 0.001)
Table 3: Bilateral: Compare pre- and post-orchidopexy testosteron and gonadotropin
Average Pre orchidopexy
n = 36
Post orchidopexy
Post orchidopexy of bilateral group - average LH, FSH reduce Average testosterone increases (p < 0.001)
Although post-operative, average FSH reduces, this hormone is still higher than the nomal value
Trang 3DISCUSSION
One year after orchidopexy, by redoing
blood test to check the change of
testosterone and gonadotropins of all the
patients, we realize the difference about
hormone levels between unilateral group
and bilateral group The improvement of
hormons is not similar in two groups The
average LH, FSH in bilateral group are
higher than unilateral one (LH: 8.4 ±
3.6 IU/L and 5.8 ± 2.0 IU/L, p < 0.001;
FSH: 15.6 ± 9.8 IU/L and 7.2 ± 5.3 IU/L,
p < 0.001) And the difference in
testosterone level in two groups is not
statistically significant despite bilateral
group’s testosteron (table 1) This result is
compatable with Lee P.A’s study showing
that average LH, FSH in bilateral group
were higher than unilateral one (FSH:
17.4 IU/L and 4.0 IU/L, p < 0.001),
(LH: 7.1 IU/L and 4.6 IU/L, p = 0.023)
There is no difference in average
testosteron level when comparing two
groups [3] Thus, after orchidopexy in
male adults, the recovery of bilateral’s
function is less than unilateral’s It means
that the function of bilateral declines more
seriously than unilateral’s if the patients
are treated late in adult age [8]
In unilateral group (table 2), although
LH, FSH levels are in normal limit
pre-operation, they trend to reduce clearly
post-operation appropriating for increment
of testosterone The difference between
pre- and post-operative showed an
improvement in testical endocrine function
as well as response of pituitary gland’s
gonadotropins
In bilateral group (table 3), there was
also an improvement in testosterone and gonadotropin after surgery However, average FSH level was higher than normal limit It demonstrates a severe harm of seminiferous tubules of male adults who are treated late by orchidopexy And the recovery of testical function in bilateral group is more difficult than unilateral’s Chiba’s research also showed
an improvement in hormone in post-operative bilateral Average FSH level was lower (23.2 ± 5.6 vs 31.9 ± 11.6 mIU/mL,
p = 0.085) Avarage LH level also was lower (6.8 ± 1.7 vs 10.9 ± 3.6 mIU/mL, p < 0.05), while testosterone level was higher (3.8 ± 2.5
vs 3.5 ± 1.9 ng/ml, p = 0.834) [1, 7]
Our research’s result is somewhat contradictory with Virnadi BS’s one in
57 male adults who were treated by orchidopexy in childhood for undescend tests (47 unilateral và 10 bilateral) His study showed that all the patients had nomal LH, FSH, testosterone [9] According
to many authors, the difference depends
on the time point of treatment and pre-or post-pubertal age
CONCLUSIONS
In male adults with cryptorchidism, orchidopexy helps patients to improve testical endocrine function However, the improvement is different between two groups: bilateral (post orchidolexy testosterone 16.2 ± 5.8 and pre-orchidolexy testosterone 14.5 ± 7.3) and unilateral (post-orchidolexy testosterone 18.8 ± 4.9 and pre-orchidolexy testosterone 17.0 ± 5.9) The improvement in pituitary’
Trang 4hormone level was clearer in bilateral
group (LH 11.6 ± 6.0 and 8.4 ± 3.6; FSH
22.0 ± 13.7 and 15.6 ± 9.8) Comparing
with male adult group, who have
orchidopexy history in childhood, the
improvement of testosterone and
gonadotropin is not good
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